Provider Demographics
NPI:1083191795
Name:HOOPER, VIRGINIA (PTA)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:
Last Name:HOOPER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45109 HOOPER LN
Mailing Address - Street 2:
Mailing Address - City:SAINT AMANT
Mailing Address - State:LA
Mailing Address - Zip Code:70774-3673
Mailing Address - Country:US
Mailing Address - Phone:225-931-3592
Mailing Address - Fax:
Practice Address - Street 1:8080 BLUEBONNET BLVD STE 10
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70810-7827
Practice Address - Country:US
Practice Address - Phone:225-408-7990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-25
Last Update Date:2018-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAA7977225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant